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PubMed1997

Depression in the community: the first pan-European study DEPRES (Depression Research in European Society).

DEPRESS (Depression Research in European Society) is the first large pan-European survey of depression in the community. A total of 13359 of the 78463 adults who participated in screening interviews across six countries were identified as suffering from depression, a 6-month prevalence of 17%. Major depression accounted for 6.9% of the cases of depression and minor depression for 1.8%. Depressed subjects in both these categories perceived that their working or social lives were substantially impaired by depressive symptoms. The remaining 8.3% of depressed subjects considered that their functional impairment was not substantial. A significant proportion of sufferers from depression (43%) failed to seek treatment for their depressive symptoms. Of those who did seek help (57%), most consulted a primary care physician, the frequency of consultation increasing with the severity of depression. Sufferers from major depression imposed the greatest demand on healthcare resources, making almost three times as many visits to their GP or family doctor as non-sufferers (4.4 vs 1.5 visits over 6 months). More than two-thirds of depressed subjects (69%) were not prescribed any treatment and when drug therapy was prescribed (31%), only 25% of these subjects were given antidepressant drugs. The number of days of work lost due to illness increased with the severity of depression. Major depression had most impact on productive work, with sufferers losing four times as many working days over 6 months as non-sufferers. The results of the DEPRES survey confirm the high prevalence of depression in the community and the burden imposed on the individual sufferer in terms of impaired quality of life and on society in terms of healthcare utilization and lost productivity.

Adult↗
PubMed1997

Use of thyroid hormone to diminish the cognitive side effects of psychiatric treatment.

Electroconvulsive therapy (ECT) and lithium are highly effective treatments for mood disorders. Both treatments, however, are associated with cognitive side effects which reduce patient compliance and treatment satisfaction. Both therapies also have a significant effect on hypothalamic-pituitary-thyroid axis (HPT) activity. Preliminary results from a double-blind, placebo-controlled study of adjunctive thyroid hormone (T3) and ECT showed better memory function in patients receiving T3 compared with placebo. This neuroprotective effect of T3 has been confirmed using electroconvulsive shock (ECS) in rats, and shown to be independent of the number of electrical stimulations. Results of studies in patients with bipolar disorder taking lithium have demonstrated that cognitive deficits are significantly related to diminished thyroid status, but not lithium levels. Preliminary evidence also shows that adjunctive thyroid hormone improves cognitive functioning in patients taking lithium. These findings, if replicated and confirmed, indicate a potential role for adjunctive thyroid hormone in reducing the cognitive side effects of these important psychiatric treatments. This, in turn, may lead to improved treatment compliance, diminished overall morbidity, and reduced healthcare utilization.

Animals↗
PubMed1997

Case management styles for people with AD: do the differences make a difference?

This two-part study examined the effectiveness of differing approaches to case management as implemented at eight Medicare Alzheimer's Disease Demonstration project sites. Researchers followed case managers as they implemented their core (or central) tasks. Results from interviews with case managers (n = 57) were used to construct a site-based typology of case management. An analysis of 922 chart summaries was then conducted. Factor analysis was used to construct six statistically distinct "types" of case management. These factors were then used to predict community-based service use, healthcare utilization, and caregiver outcomes. Analysis indicated that styles of case management do make a difference in service use and caregiver outcome but have less effect on health care utilization outcomes.

Alzheimer Disease↗
PubMed1999

Chronic pain: primary care treatment of the older patient.

The prevalence of chronic diseases associated with pain increases with age, and pain prevalence appears to increase with the level of functional dependence. Chronic pain in older patients is associated with sleep disorders, impaired physical and social function, and increased healthcare utilization. Symptoms of pain, anxiety, and depression are often associated and may intensify each other. Because a complete resolution of chronic pain is unlikely, it is important to establish early in therapy the level of pain that the patient would find acceptable. The goal of therapy is to treat chronic pain while minimizing side effects and optimizing the patient's functional status.

Aged↗
PubMed1998

The cost of inpatient endometriosis treatment: an analysis based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample.

OBJECTIVE: To determine the prevalence and cost of endometriosis-related hospitalizations based on the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP-3). STUDY DESIGN: Retrospective analysis based on nationwide clinical practice data. PATIENTS AND METHODS: Data were obtained for 1991 and 1992 from the HCUP-NIS database, which was a 20% sample of all US hospital discharges. ICD-9 codes (236.0, 617.0 to 617.9) were used to identify females, aged 15 to 54, with endometriosis as a diagnosis. The distribution of endometriosis admissions by admission type, length of stay (LOS), mean total charge, specific types of endometriosis, principal procedures, and other diagnosed diseases was described. RESULTS: In 1991 and 1992, 37,273 (22.6/1000) and 38,834 (23.7/1000) hospital admissions, respectively, were for endometriosis (as any diagnosis). The average LOS and total hospital charges for endometriosis as the primary diagnosis were 3.8 days and $6,597 for 1991, and 3.5 days and $7,450 for 1992. Most endometriosis admissions occurred in females aged 35 to 49. About 87% of the endometriosis hospitalizations were routine admissions. The most common diagnosis was endometriosis of the uterus (51%); the most common procedure was a total abdominal hysterectomy (55%-60%). Older and African-American patients had the longest LOS and the highest total charges. The estimated total hospitalization costs, as represented by hospital charges, for women with endometriosis as the primary diagnosis in the United States were $504 million for 1991 and $579 million for 1992. CONCLUSION: Endometriosis-related hospitalization is a major burden on healthcare systems.

Adolescent↗
PubMed1999

Characteristics of hospitalizations of HIV-infected patients: an analysis of data from the 1994 healthcare cost and utilization project.

Hospitals are significant resources for care of HIV/AIDS patients. Previous studies that have attempted to identify and track the characteristics of these patients and their hospitalizations have been limited in their ability to produce national estimates of patient use of such resources. This study, using data from the Healthcare Cost and Utilization Project (HCUP-3) attempted to characterize and estimate the cost of hospital usage by HIV/AIDS patients. We estimate that in 1994 approximately 188,506 admissions of HIV/AIDS patients occurred with an average charge of $19,244 U.S. per admission, for an estimated total cost of $3.63 billion. Compared with non-HIV-infected patients, HIV/AIDS patients tended to be male (75.83% versus 41.49%), a member of a minority group (53.51% versus 20.77%), hospitalized in a private, nonprofit, urban teaching hospital with a longer average length of stay (10.27 versus 5.52 days), and to have a higher in-hospital mortality (11.45% versus 2.58%). Approximately half of the hospital charges (47%) for these admissions were absorbed by Medicaid, and 25% by private insurance. The remainder of the charges were borne by the patients themselves. The results presented here for 1994 predate the widespread use of protease inhibitor/ highly active antiretroviral therapy (HAART), thus making this study an important benchmark for the delineation of the effects of HAART and any other future developments in HIV therapy on the characteristics of HIV/AIDS patient resource use on a national level. This study further demonstrates that HCUP is a powerful tool for the estimation and costing of hospital resource use.

Adult↗
PubMed1998

Coronary angioplasty outcomes in the Healthcare Cost and Utilization Project, 1993-1994.

It is estimated that >400,000 percutaneous transluminal coronary angioplasty (PTCA) procedures are performed in the Unites States annually. This study reports patient characteristics and outcomes for 163,527 PTCAs performed in 214 hospitals in 17 states from 1993 to 1994. These hospitals were a 20% random sample of hospitals in the Healthcare Cost and Utilization Project, which was designed to reflect hospitalization in the United States, generally. Cases with International Classification of Diseases, 9th Revision, Clinical Modification procedure codes 36.01, 36.02, and 36.05 were defined as PTCA and were categorized as to whether acute myocardial infarction (AMI) was the principal discharge diagnosis. The average age of 44,270 AMI discharges (27%) was 62 +/- 12 years and that of 119,257 no-AMI cases (73%) was 64 +/- 11 years; 1/3 of both groups were women, 88% were white, and almost 90% had Medicare or private insurance as the primary payer. The states contributing the most cases were Florida (26%), California (12%), and Wisconsin (10%). Hospital mortality was 1.7% overall and was 3.8% for AMI and 0.8% for no-AMI cases. Bypass surgery performed during the same admission was 3.4% overall and was 4.5% and 3.0% for AMI and no-AMI cases, respectively. Multivariate analysis showed that advanced age, diabetes, female gender, and Medicaid payer status were associated with increased risk of mortality. National estimates from this 20% sample indicate that >850,000 PTCAs were performed in the 2 years, with 452,319 cases estimated for 1994. In 1994 there were an estimated 2,789 deaths and 9,903 bypass surgeries in the no-AMI subset of 327,856 procedures. For the AMI group of 124,463 procedures, there were 4,486 deaths and 5,799 bypass surgeries in 1994. This study of PTCA outcomes contains the largest number of cases as well as the most representative sample reported to date.

Angioplasty, Balloon, Coronary↗
PubMed1999

Secondary data bases and their use in outcomes research: a review of the area resource file and the Healthcare Cost and Utilization Project.

Secondary data sources are being used more frequently than ever in outcomes research. The speed and relative low cost of these data bases makes them ideal for analyzing outcomes. Today's researcher has numerous secondary data bases available for use. Few publications exist to help researchers locate the ideal data set for their needs. Herein, two national secondary data bases are reviewed: the Area Resource File (ARF) and the Healthcare Cost and Utilization Project (HCUP). These two data sets represent the two types of secondary data: aggregate and individual. ARF represents an aggregate data set and HCUP represents an individual data set. The advantages of each type of secondary data will also be reviewed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Effects of pulmonary rehabilitation on dyspnea, quality of life, and healthcare costs in California.

PURPOSE: This study evaluated pulmonary rehabilitation as practiced in the general California medical community to determine its effectiveness in improving dyspnea and health-related quality of life and reducing the use of healthcare resources. METHODS: For this study, 10 established pulmonary rehabilitation programs agreed to collect common clinical health outcome data on consecutive patients over 2 years. The following three self-administered questionnaires were obtained before and after rehabilitation, then at 3-, 6-, 12-, and 18-month follow-up assessments: Medical Outcomes Survey Short Form (SF-36), University of California, San Diego Shortness of Breath Questionnaire (SOBQ), and Health Care Utilization in the preceding 3 months. Information also was collected on patient demographics, diagnostic categories, use of supplemental oxygen, and available spirometry and 6-minute walk tests. RESULTS: Nine centers enrolled 647 patients that met prespecified inclusion criteria. Of these, 521 completed the rehabilitation program and both the pre- and the postprogram assessment. At least two of the four follow-up assessments were completed by 415 patients in eight centers. The mean age of the patients was 68 years, and 42% were men. Overall, the forced expiratory volume in 1 second was 44% of the predicted value. There were few significant differences between the centers. The baseline outcome measures demonstrated marked symptoms, as evidenced by the mean SOBQ score (56.8) and the mean impaired quality of life results (SF-36 physical component score, 31.2; SF-36 mental component score, 47.5). These measures also showed high utilization of healthcare services over the preceding 3 months in terms of mean hospital stay (2.4 days), urgent care visits (0.4), physician visits (4.4), and telephone calls (2.7). After rehabilitation, there were significant improvements in symptoms and quality of life in all the centers, as evidence by mean changes of -6.8 for the SOBQ, 7.5 for the physical component score, and 3.9 for the mental component score). Over 18 months, benefits gradually declined, but levels remained above baseline values. There also were significant reductions in all measures of healthcare utilization. CONCLUSIONS: Pulmonary rehabilitation was effective in improving symptoms and quality of life and reducing the utilization of healthcare resources over 18 months. The results were consistent across participating centers despite variations in practice settings, patient referral patterns, and program structure.

Aged↗
PubMedDate not supplied

The utilization of the healthcare assistant role in intensive care.

The increasing role of healthcare assistants (HCAs) in intensive care in relation to patient monitoring has raised concerns among some clinical managers, particularly where such roles are not underpinned by a sound knowledge base and critical reasoning ability. This article describes a study which was undertaken in an attempt to identify how HCAs are currently utilized within the general intensive care environment. The results show a wide variation between units in relation to the activities undertaken by HCAs, their training and the levels of remuneration. This article seeks to open up the debate as to whether or not nurses should be challenging the nursing care that is now delivered by non-nurses and makes recommendations for the way forward in this area.

Critical Care↗
PubMedDate not supplied

Utilization management and healthcare reform.

The reform movement in healthcare is occurring in response to financial pressures on American business. The trend toward managed care with competition-based discounting and capitation contracts is likely to continue even if Congress does not enact healthcare reform legislation. Efficient management of resources with acceptable outcomes and customer satisfaction is becoming increasingly crucial. As cost-shifting options are reduced, accurate knowledge and management of resource consumption costs become critical to enable hospitals to assume the financial risks associated with competing in any future capitation area. Hospitals must consider altering their approach to utilization management and business as usual to survive these changes.

Cost Control↗
PubMedDate not supplied

Exploring the utility of automated drug alerts in home healthcare.

Computerized drug utilization review (DUR) can potentially reduce adverse drug events. We examined automated DUR for home healthcare patients with diabetes or hypertension. Sixty-eight percent of diabetes patients and 50.7% of hypertension patients triggered severe, moderate, or duplicative alerts. Among diabetes patients, 74.3% of duplicative alerts were trivial or inappropriate, compared with 3.9% among hypertension patients. Experts judged that 40.5% of high-risk diabetes patients and 53.6% of hypertension patients had alerts requiring nurse follow-up. Adequate follow-up was significantly lower for the former. The relationship between inappropriate alerts and poorer follow-up reinforces the need for more specific alert systems to focus clinicians' attention on clinically important alerts.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Effect of provider volume on resource utilization for surgical procedures of the knee.

Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997-2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7-7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6-2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p < or = 0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.

Adult↗
PubMed2000

Finger replantation in the United States: rates and resource use from the 1996 Healthcare Cost and Utilization Project.

Although finger replantation has been performed by hand surgeons in the United States for over 30 years the epidemiology of this procedure has not been studied. We used a national sampling database from the Agency for Health Care Policy and Research to summarize descriptive statistics surrounding finger replantation in the United States. This sample contained 304 cases of finger replantation performed in 1996. Mean hospital length of stay was 5.5 days and mean total charges were $20,330. Of the 906 hospitals included in this database, only 136 performed finger replantation during 1996. Of those, 60% performed only one case and 2% performed 10 or more cases. This descriptive analysis provides an examination of the largest sample size to date of finger replantation in the United States. Epidemiologic studies using national databases can provide researchers and policy makers with the analyses needed to examine treatment options and appropriately allocate future health care resources.

Adult↗
PubMed1999

Association between percutaneous transluminal coronary angioplasty volumes and outcomes in the Healthcare Cost and Utilization Project 1993-1994.

Studies from a variety of settings have indicated that outcomes for coronary angioplasty are improved when performed in institutions with high caseloads (> 400/year). The purpose of this investigation was to examine the volume outcome hypothesis for coronary angioplasty in a 20% stratified sample of acute care, non-federal hospitals in 17 states. Data were derived from the Nationwide Inpatient Sample from the Health Care Cost and Utilization Project releases 2 and 3. From these records, 163,527 angioplasties from 214 hospitals were selected. Outcomes included hospital mortality, same-admission coronary artery bypass surgery, and a combined end point of either death or same-admission surgery, or both. Hospital volumes were defined as low (< or = 200 cases/year), medium (201 to 400), and high (> 400). Analyses were conducted separately for patients with and without a principal discharge diagnosis of acute myocardial infarction (AMI). For both AMI and no-AMI groups, the rates of adverse outcomes were generally lower in high-volume institutions, and this finding was true in both univariate and multivariate analyses. Although 27% of hospitals were in the low-volume category, only 5% of all procedures were performed in these institutions. Projecting to all United States hospitals for the 2 years, if all procedures performed in low-volume centers had been done in high-volume institutions, 137 deaths could have been averted (90 AMIs, 47 no-AMIs) as well as 404 (46 AMIs, 358 no-AMIs) same-admission surgeries. The results of this study support the hypothesis that better results are obtained in higher volume institutions, but also show that in 1993 and 1994, relatively few patients had their procedures performed in low-volume institutions.

Angioplasty, Balloon, Coronary↗
PubMed2001

Improved outcomes associated with stenting in the healthcare cost and utilization project.

Recent results from Medicare indicated that both hospital mortality and the use of same admission coronary artery bypass graft (CABG) surgery were lower in patients receiving stents, and that stenting did not alter the finding of improved outcomes at high volume centers. The purpose of this report is to compare outcomes in a national sample of patients of all ages receiving stents with those undergoing conventional balloon angioplasty. A second purpose is to evaluate the volume outcome hypothesis. This study included 100,318 angioplasties from 191 hospitals in 19 states; 43,966 (44%) involved stent placement. The major outcomes of interest were same admission hospital death and same admission CABG surgery. In comparison to patients with conventional angioplasty, patients receiving stents were younger, less often female and nonwhite, and had less diabetes and hypertension. In the group without infarction, hospital mortality was lower in the stent group (0.7% vs 0.9%, P = 0.01), as was the use of same admission bypass surgery (1.4% vs 2.7%, P < 0.0001). The same pattern was true for myocardial infarction; hospital mortality (2.7% vs 4.2%, P < 0.0001) and bypass surgery rates (1.6% vs 5.3%, P < 0.0001) were lower in the stent group. These results persisted after adjustment for important predictors of outcome. In general, outcomes were better in high volume centers, although in the stent group, there was no clear relationship between volume and outcome. These results support earlier findings that hospital mortality and particularly same admission surgery rates are lower with stenting. Although the volume outcome association for stenting was less clear in this study than in Medicare, these results do not mean that the fundamental volume outcome relationship has been changed by stenting.

Aged↗
PubMed2005

Medicaid programme changes and the chronically ill: early results from a prospective cohort study of the Oregon Health Plan.

OBJECTIVE: To describe the impacts of recent Oregon Health Plan (OHP) policy changes on individuals living with chronic illness in Oregon. METHODS: A mail survey was conducted of 1374 OHP beneficiaries who were directly affected by the new policies. The analyses reported in this article represent baseline findings from the first of three survey waves in an ongoing prospective cohort study. RESULTS: A significant association was found between Medicaid policy changes and high rates of disenrolment from the OHP. Compared to the non-chronically ill, the chronically ill were more likely to report inability to pay for medications, higher medical debt, more unmet health needs, and poorer health status. Among the chronically ill, those who lost insurance reported decreased access to and utilization of healthcare, more medical debt, and more restriction of medications. DISCUSSION: As policy-makers restructure public programmes to accommodate tight budgets and rising healthcare costs, people with chronic illness can easily be overlooked. Chronically ill individuals face disproportionate financial and health burdens. Small cost-saving policy changes can lead to widespread disenrolment that cascades into reduced access to healthcare services, altered utilization patterns, and financial strain.

Adult↗